Joe Layng- Topical vs. Systematic Clinical Interventions

1.0 Type II CE Credits 

This presentation was recorded at the 2015 Cambridge Center for Behavioral Studies Annual Meeting

About this presentation: 

In 1979, Israel Goldiamond first described the distinction between topical and systemic clinical intervention. He later refined the distinction in 1984 and since that time his students have continued to expand on and extend the approach (Layng and Andronis, 1984; Layng, 2006; 2009). At the heart of the intervention is a Constructional Approach that employs a nonlinear contingency analysis. In Topical intervention the presenting complaint is either treated directly or its function is determined and intervention proceeds accordingly. However, one may also consider the consequences contingent not only on the disturbing pattern, but the consequences contingent on its alternatives as well. The resolution of the resulting contingency matrix accounts for the pattern. This category of Topical intervention seeks to understand the matrix by attending to the outcomes (costs and benefits) of both the disturbing pattern and its available alternatives. Though costly and jeopardizing to the client, the disturbing pattern is considered a rational and sensible resolution of the matrix. A Systemic intervention also considers the matrix into which the disturbing pattern enters, but asks what potentiates the consequences and their relations. Often, other behavioral contingencies that are a part of yet other matrices may be the source of such potentiation. Intervention may be targeted at these Systemic relations and not at all at the presenting complaint or the matrix into which it enters. The presenting complaint is considered a symptom of these Systemic relations whose resolution may result in the “dropping out” of the disturbing behavior without direct intervention. Clinical examples will be presented and it will be suggested that a nonlinear analysis may reduce the need to resort to hypothetical self-generated rules or escape from private events as explanations for behavior of clinical interest.